Local hospitals supportive of new bill but still wary

Thursday

Aug 2, 2012 at 12:01 AMAug 2, 2012 at 2:04 AM

A new bill to tame state health care spending presents both an opportunity and a challenge, local hospitals say, giving them an advantage against higher-price competitors but potentially leaving less money to protect jobs and medical services.

Michael Morton/Daily News staff

A new bill to tame state health care spending presents both an opportunity and a challenge, local hospitals say, giving them an advantage against higher-price competitors but potentially leaving less money to protect jobs and medical services.

After a negotiated compromise on the provisions, the House and Senate voted Tuesday to send the legislation to Gov. Deval Patrick, who is expected to sign it. Given that annual rises in health care spending have averaged 6.8 percent, starting in 2013 the bill would cap increases at state economic growth, around 3.6 percent in recent years.

Hospitals and doctors that go over would have to provide explanations and face possible fines for repeat problems. But the legislation also encourages new systems for coordinated care that many local providers have already implemented and promotes the use of insurance plans where patients are rewarded for using cheaper community hospitals over their more expensive Boston counterparts.

Legislative leaders say the legislation will save $200 billion over the next 15 years and lead to lower insurance premiums for businesses and residents.

"It's going to be challenging, but it is an opportunity," said Karen Moore, president and CEO of Marlborough Hospital, which has been preparing for possible changes for several years. "The legislation isn't perfect, but it moves us in a direction we need to go."

Like other hospitals, Milford Regional Medical Center continues to trim unneeded costs, supports the move toward affordable care and appreciates the Legislature's work, said CEO Frank Saba. But Saba, who like other providers was still wading through the 350-page bill Wednesday, also expressed doubt about the target's depth and timing.

"We still have to figure out what it means and how it's calculated and how it affects the individual hospital," he said.

Sen. Richard Moore, D-Uxbridge, a lead negotiator, said a new state number-crunching group would make referrals to the renamed Health Policy Commission, which would employ flexibility and "common sense" in working with providers.

At Atrius Health, an alliance of physician practices that includes Southborough Medical Group, CEO and President Dr. Gene Lindsey said the group has worked for years to eliminate redundant or unneeded care, with full electronic medical records and patients able to book appointments and access all their information online.

"We believe we're as prepared as anybody," Lindsey said of the legislation.

Separately, Moore said a dropped House proposal for a one-time "luxury tax" would not have worked to temper hospitals and doctor groups receiving higher payments because of name-brand recognition or geographic dominances - disparities Attorney General Martha Coakley has cited as a factor in rising costs.

Given that the Legislature did not want to be "overly prescriptive and regulatory," Moore said, the legislation establishes a special commission to track prices, assess when higher payments are warranted and refer cases to Coakley when it seems they are not. The bill also promotes online posting of procedure prices and quality measurements.

"It certainly drags it into the light of day more than it has in the past," said Dennis Irish, a spokesman for Vanguard Health Systems, owner of MetroWest Medical Center. The hospital has repeatedly complained that it can't compete with higher-paid providers.

The legislation also:

Establishes a new employer tax credit for workplace wellness programs, plus mandated insurance breaks for firms that participate
Gives small businesses a break, raising the requirement for providing insurance from 10 full-time employees to 20
Allows physician assistants and nurse practitioners to serve as primary care providers, helping address a shortage
Requires insurers to disclose out-of-pocket costs upfront and to make statements clearer
Reforms medical malpractice by requiring a 182-day period before suits are filed and encouraging apologies and quicker settlements.

State House News Service material was used in this report.

(Michael Morton can be reached at 508-626-4338 or mmorton@wickedlocal.com.)